- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,011.87 / $10,964.78
| Facility | | $4,677.35 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,623.41 / $10,964.78
| Professional | | $4,466.84 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $13,182.57
| Facility | | $7,585.78 | $7,585.78 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $7,585.78
| Professional | | $6,456.54 | $6,456.54 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $7,762.47 / $13,803.84
| Professional | | $4,677.35 | $7,762.47 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $50.12
| Professional | | $39.81 | $39.81 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,709.64 / $14,125.38
| Facility | | $6,918.31 | $8,709.64 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,754.40 / $13,803.84
| Professional | | $5,011.87 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Professional | | $11,220.18 | $11,220.18 | $11,220.18 |